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GREENSBORO — What happens when a critical care hospital patient develops uneven heart rhythms at 3 a.m.?

At the four campuses of Moses Cone Health System, a computer system would alert a nurse at a computer console immediately. That nurse would consult with a nurse in the patient’s room.

If an intensive care specialist were needed, one would be in the computer system’s control room, able to give direction to the nurses in the patient’s room. The physician could even zoom in with a camera to check on the patient’s monitors and appearance, even to the detail of how the patient’s eyes were reacting to light.

That’s how Cone’s eLink critical care system works. The $4.2 million system, in place since December and the only one of its kind in North Carolina, provides centralized, real-time monitoring of all 97 critical care beds in the four Cone campuses, including Annie Penn Hospital in Reidsville and Moses Cone, Wesley Long Community Hospital and Women’s Hospital in Greensboro.

The system incorporates X-rays, lab tests, pharmacy orders and all other facets of each patient’s care plan so that a nurse or doctor can call everything up quickly and the patient’s attending physician can be kept informed.

A nurse or physician in the patient’s room can contact the center by phone or intercom and get the information she needs. And an intensive care specialist works from 7 p.m. to 7 a.m. nightly to monitor the data and, if necessary, attend to a patient in person or page another physician to do so.

The system is intended to improve and speed care to patients, analyze trends in data to catch small problems before they turn into big ones and reduce the time patients spend in intensive care.

It’s an ambitious goal, and an important one. About 4 million Americans enter intensive care units every year, and 500,000 of them die. Units supervised by intensive care specialists can prevent more deaths, but such specialists are rare and many smaller or rural hospitals don’t have them. The system’s maker, Visicu, claims its client hospitals have reported a 25 percent decrease in deaths among intensive-care patients.

Cone hasn’t been using the system long enough to try to measure any change, but its users are confident that it works.

"We’re able to more closely monitor our patients at night," said Dr. Patrick Wright, one of the intensive care specialists who shares overnight duties at Moses Cone.

"We’re able to identify problems earlier in their course of development," he said. "We are able to write orders through the system and able to, if you will, reverse patients who are declining or deteriorating much more quickly."

Wright says he and nine colleagues who rotate through the night shifts stay busy beyond monitoring patients and reviewing data and care plans: "There are two or three patients a night who are getting a significant intervention that’s helping."

In addition to lives saved, that time saved also translates into financial savings — a case of ventilator-associated pneumonia, for example, can add thousands to a patient’s bill if not caught early.

And there’s no additional cost in relation to what critical care cost before the system was installed, said Joan Wessman, the chief nursing officer.
Cone has adapted well to its new system, according to a comparison with other hospitals using it. During the first three months of 2007, Cone’s care practices — adherence to a number of best practices indicated for critical care patients — ranked sixth out of Visicu’s 27 systems in use, said Phyllis Griffin, the system’s director at Cone.

And since the system went into use, the average patient stay in intensive care has declined from 4.2 days during 2006-07 to 3.5 days from installation through July, Griffin said.

The system also helps Cone retain experienced nurses by offering them another venue in which they can use their skills to watch and help patients, Wessman said.

That watching is done by operators in an open, airy room on the top floor of a building on East Northwood Street across from the main Moses Cone campus. Operators at four work stations each watch four eLink screens arranged in a square, with a fifth to one side.

One of the eLink screens shows what the camera in a patient’s room is seeing. One takes note of alerts the system is sending regarding that patient. The others can pull up patient care plans, pharmacy orders, radiological records or any other data stored by eLink for that patient.

A fifth monitor, not part of eLink, mirrors what the patient’s bedside monitor is showing, such as pulse and blood pressure.

The camera shows pictures in the highest of definitions.

"It’s a very good view for the physician," Griffin said.  "You can count (patients’) pores."

The camera also can zoom in on equipment and monitors in the patient’s room.

Each of the four work stations is assigned a share of the Cone system’s 97 intensive-care beds, of which 90 or more typically are in use at any time.

The system makes work easier for intensive care nurses, said Renee Amburn, director of Cone’s Medical/Surgery Intensive Care Unit.

Even though unit nurses typically are assigned only two patients, eLink can help monitor one of those patients while the nurse provides bedside care to either one, particularly if a nurse’s other patient is experiencing a crisis, Amburn said.

"It increases our confidence, knowing that someone can watch things if we’re not physically in the room."

Contact Lex Alexander at 373-7088 or lalexander@news-record.com